In recent years it has been a matter of some concern to psychiatrists and others in the West that political dissidents in the Soviet Union have been diagnosed as mentally ill and have been involuntarily confined to psychiatric hospitals for treatment. It has thus been argued that Soviet psychiatrists have been guilty of the misuse of their psychiatric powers for political ends, usually on the grounds that the dissidents confined to hospital are in fact mentally well. In this paper it is shown that Western commentators cannot be complacent about their ability to defend this position because: (a) the concept of mental illness is unclear; (b) even so far as the concept of mental illness can be made clear it may be difficult to determine whether particular individuals — either in the West or the East — are mentally ill or mentally well; (c) in any case, illness qua illness cannot be a justification for compulsory treatment. It is suggested that there may be grounds for the compulsory treatment of individuals who lack rational autonomy, so long as rational autonomy is defined in a particular way. However, it is unlikely that this concept can be used to distinguish between the practices of Soviet and Western psychiatrists because many patients diagnosed as severely mentally ill may be able to demonstrate rational autonomy.
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